{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:59:33Z","timestamp":1786625973487,"version":"build-2736575974"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T00:00:00Z","timestamp":1680220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background Aneurysmal rupture in the aortoiliac segment is a severe, life-threatening condition. Nowadays, in addition to surgical treatment, the implantation of a covered stent graft constitutes a feasible, minimally invasive treatment option. A novel approach is the add-on of transarterial aneurysm sac embolization with N-butyl-cyanoacrylate (NBCA). Here, we report our experience of performing this add-on embolization procedure after endovascular aneurysm repair for complex ruptured aneurysms of the aortoiliac segment. Material and Methods We describe six patients (mean age of 75.2 years; all male) with ruptured aneurysms in the visceral aortic and aortoiliac segment in whom a high-volume transarterial aneurysm sac embolization was performed as an add-on therapy to the implantation of an aortic prosthesis. The aim of this add-on intervention was to achieve the definite embolization of the aneurysmal rupture site and to ensure the best possible aneurysmal sealing. We report the feasibility, technical success, and considerations of using NBCA as well as clinical and follow-up imaging results, given their availability. Results Technical success was achieved in all cases. Clinical success was achieved in four cases. No periprocedural complications or reinterventions were reported. The mean full procedure time was 107.8 min. The mean radiation dose was 12,966.1 cGy\/cm2. A mean amount of 10.7 mL of NBCA mixed with lipiodol in a 1:3 to 1:5 ratio was used for all patients. Available follow-up imaging up to 36 months after the procedure showed no aneurysm progression or endoleaks. In two patients, the NBCA cast had almost fully dissolved over the course of follow-up. Conclusions Our study underscores the notion that aneurysm sac embolization using high volumes of NBCA with ethiodized oil as an embolic agent is a feasible and add-on treatment option for optimizing the exclusion of the aneurysm from patients with ruptured aneurysms in the aortoiliac segment.<\/jats:p>","DOI":"10.3390\/life13040919","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T09:12:59Z","timestamp":1680253979000},"page":"919","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Endovascular Aneurysm Sac Embolization for Treatment of Ruptured Aneurysms in the Aortoiliac Segment Using N-Butyl-Cyanoacrylate"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9372-9006","authenticated-orcid":false,"given":"Karim","family":"Mostafa","sequence":"first","affiliation":[{"name":"Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Schierenbeck","sequence":"additional","affiliation":[{"name":"Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Trentmann","sequence":"additional","affiliation":[{"name":"Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Gottschalk","sequence":"additional","affiliation":[{"name":"Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Pfarr","sequence":"additional","affiliation":[{"name":"Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malte","family":"Sieren","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus L\u00fcbeck, 23569 L\u00fcbeck, Germany"},{"name":"Institute of Interventional Radiology, University Hospital Schleswig-Holstein, Campus L\u00fcbeck, 23569 L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olav","family":"Jansen","sequence":"additional","affiliation":[{"name":"Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp J.","family":"Sch\u00e4fer","sequence":"additional","affiliation":[{"name":"Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ejvs.2018.09.020","article-title":"Editor\u2019s Choice\u2014European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms","volume":"57","author":"Wanhainen","year":"2019","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_2","unstructured":"National Institute for Health and Care Excellence (NICE) (2020, March 19). Abdominal Aortic Aneurysm: Diagnosis and Management [Nice Guideline 156]. Available online: https:\/\/www.nice.org.uk\/guidance\/ng156."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Mostafa, K., Pfarr, J., Langguth, P., Sch\u00e4fer, J.P., Trentmann, J., Koktzoglou, I., Edelman, R.R., Neves, F.B., Graessner, J., and Both, M. (2022). Clinical Evaluation of Non-Contrast-Enhanced Radial Quiescent-Interval Slice-Selective (QISS) Magnetic Resonance Angiography in Comparison to Contrast-Enhanced Computed Tomography Angiography for the Evaluation of Endoleaks after Abdominal Endovascular Aneurysm Repair. J. Clin. Med., 11.","DOI":"10.3390\/jcm11216551"},{"key":"ref_4","first-page":"e071452","article-title":"Use of linked registry claims data for long term surveillance of devices after endovascular abdominal aortic aneurysm repair: Observational surveillance study","volume":"379","author":"Goodney","year":"2022","journal-title":"BMJ (Clin. Res. Ed.)"},{"key":"ref_5","first-page":"98","article-title":"N-butyl cyanoacrylate embolotherapy: Techniques, complications, and management","volume":"24","author":"Hill","year":"2018","journal-title":"Diagn. Interv. Radiol."},{"key":"ref_6","first-page":"1562432","article-title":"Emergent Uterine Arterial Embolization Using N-Butyl Cyanoacrylate in Postpartum Hemorrhage with Disseminated Intravascular Coagulation","volume":"2017","author":"Obata","year":"2017","journal-title":"Bio. Med. Res. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1097\/01.RVI.0000133505.84588.8C","article-title":"N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage","volume":"15","author":"Kish","year":"2004","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1136\/jnis.2010.002501","article-title":"Vascular inflammation with eosinophils after the use of n-butyl cyanoacrylate liquid embolic system","volume":"3","author":"Quinn","year":"2011","journal-title":"J. NeuroInterv. Surg."},{"key":"ref_9","first-page":"777","article-title":"n-Butyl 2-cyanoacrylate\u2014Substitute for IBCA in interventional neu-roradiology: Histopathologic and polymerization time studies","volume":"10","author":"Brothers","year":"1989","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1583\/10-3084.1","article-title":"Treatment of type I endoleak after endovascular repair of infrarenal abdominal aortic aneurysm: Success of fibrin glue sac embolization","volume":"17","author":"Lu","year":"2010","journal-title":"J. Endovasc. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1007\/s11547-020-01247-2","article-title":"Direct percutaneous embolization of aneurysm sac: A safe and effective procedure to treat post-EVAR type II endoleaks","volume":"126","author":"Fanelli","year":"2021","journal-title":"Radiol. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s00270-014-0873-6","article-title":"Sac angiography and glue embolization in emergency endovascular aneurysm repair for ruptured abdominal aortic aneurysm","volume":"38","author":"Koike","year":"2015","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1583\/05-1574MR.1","article-title":"Fibrin glue aneurysm sac embolization at the time of endografting","volume":"12","author":"Zanchetta","year":"2005","journal-title":"J. Endovasc. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.jvir.2014.01.012","article-title":"Double coaxial microcatheter technique for transarterial aneurysm sac embolization of type II endoleaks after endovascular abdominal aortic repair","volume":"25","author":"Hongo","year":"2014","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1007\/s00270-013-0567-5","article-title":"Transarterial embolization of type II endoleaks after Evar: The role of ethylene vinyl alcohol copolymer (Onyx)","volume":"36","author":"Wohlgemuth","year":"2013","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1583\/09-3004.1","article-title":"Aneurysm sac \u201cthrombization\u201d and stabilization in EVAR: A technique to reduce the risk of type II endoleak","volume":"17","author":"Ronsivalle","year":"2010","journal-title":"J. Endovasc. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.jvs.2013.07.104","article-title":"Intraprocedural and postprocedural perigraft arterial sac embolization (PASE) for endoleak treatment","volume":"59","author":"Levin","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1177\/1526602820923954","article-title":"Feasibility and Safety of Sac Embolization Using N-Butyl Cyanoacrylate in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms or Isolated Iliac Artery Aneurysms","volume":"27","author":"Ohba","year":"2020","journal-title":"J. Endovasc. Ther."},{"key":"ref_19","first-page":"CD010185","article-title":"Totally percutaneous versus surgical cut-down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair","volume":"1","author":"Wang","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_20","unstructured":"Bundesamt f\u00fcr Strahlenschutz (2023, January 20). Bekanntmachung der Aktualisierten Diagnostischen Referenzwerte f\u00fcr Diagnostische und Interventionelle R\u00f6ntgenanwendungen. Available online: https:\/\/www.bfs.de\/SharedDocs\/Downloads\/BfS\/DE\/fachinfo\/ion\/drw-roentgen.pdf?__blob=publicationFile&v=9."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ejvs.2015.09.007","article-title":"Systematic Review and Meta-analysis of Factors Influencing Survival Following Abdominal Aortic Aneurysm Repair","volume":"51","author":"Khashram","year":"2016","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Amsterdam Acute Aneurysm Trial Collaborators (2013). Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: A multicenter. J. Vasc. Surg., 58, 1424\u20131425.","DOI":"10.1016\/j.jvs.2013.09.023"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"f7661","DOI":"10.1136\/bmj.f7661","article-title":"Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial","volume":"348","author":"Powell","year":"2014","journal-title":"BMJ"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.ejvs.2015.03.028","article-title":"Editor\u2019s Choice\u2014ECAR (Endovasculaire ou Chirurgie dans les An\u00e9vrysmes aorto-iliaques Rompus): A French Randomized Controlled Trial of Endovascular Versus Open Surgical Repair of Ruptured Aorto-iliac Aneurysms","volume":"50","author":"Desgranges","year":"2015","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.jvs.2017.10.044","article-title":"The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm","volume":"67","author":"Chaikof","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/S0741-5214(00)70075-9","article-title":"Early complications and endoleaks after endovascular abdominal aortic aneurysm repair: Report of a multicenter study","volume":"31","author":"Buth","year":"2000","journal-title":"J. Vasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1067\/mva.2000.109990","article-title":"Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience. European Collaborators on Stent\/graft techniques for aortic aneurysm repair","volume":"32","author":"Harris","year":"2000","journal-title":"J. Vasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1067\/mva.2002.118823","article-title":"Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: The EUROSTAR experience","volume":"35","author":"Buth","year":"2002","journal-title":"J. Vasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/S0741-5214(03)00084-3","article-title":"Management of endoleak after endovascular aneurysm repair: Cuffs, coils, and conversion","volume":"37","author":"Faries","year":"2003","journal-title":"J. Vasc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ejvs.2012.11.010","article-title":"Transcatheter embolisation of type 1 endoleaks after endovascular aortic aneurysm repair with onyx: When no other treatment option is feasible","volume":"45","author":"Chun","year":"2013","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"131","DOI":"10.3400\/avd.cr.15-00015","article-title":"Life-Saving Embolization in a Patient with Recurrent Shock Due to a Type II Endoleak after Endovascular Aortic Repair for a Ruptured Abdominal Aortic Aneurysm","volume":"8","author":"Ogawa","year":"2015","journal-title":"Ann. Vasc. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S0967-5868(98)90012-1","article-title":"Disrupted and migrated microcatheter in the vertebrobasilar artery system in endovascular embolization of cerebellar AVM: Failure of endovascular and microneurosurgical retrieval","volume":"5","author":"Ito","year":"1998","journal-title":"J. Clin. Neurosci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1136\/neurintsurg-2014-011165","article-title":"N-butyl cyanoacrylate embolization using a detachable tip microcatheter: Initial experience","volume":"7","author":"Paramasivam","year":"2015","journal-title":"J. NeuroInterv. Surg."},{"key":"ref_34","first-page":"135","article-title":"Dissolution of isobutyl 2-cyanoacrylate on long-term follow-up","volume":"10","author":"Rao","year":"1989","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1177\/1591019917728400","article-title":"Urticarial reaction following endovascular embolization of an orbital arteriovenous malformation (AVM) with n-butyl cyanoacrylate (nBCA) glue","volume":"23","author":"Sinha","year":"2017","journal-title":"Interv. Neuroradiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1055\/s-2004-831406","article-title":"The use of cyanoacrylate adhesives in the management of congenital vascular malformations","volume":"21","author":"Rosen","year":"2004","journal-title":"Semin. Interv. Radiol."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/4\/919\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:07:26Z","timestamp":1760123246000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/4\/919"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,31]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["life13040919"],"URL":"https:\/\/doi.org\/10.3390\/life13040919","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,31]]}}}